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Wednesday, August 4, 2010

Taking the cat out of MCAT

Here's an interesting story from the NY Times that appeared while we were out of town. It's about an idea that cycles around once a generation or so; medical schools that admit a few students who have not taken organic chemistry or physics, nor even their MCAT qualifying test. A study has found that the humanist med students did as well as the driven pre-med majors did. Perhaps they were even better, more sensitive and less techy docs.

These artsy admittees were good students, not just goof-offs as undergrads, but they were not cookie-cutter students after high GPAs come what may, or walk over whosoever's in the way. If any reader has trained pre-meds, we need say no more.

It's partly the system. The pre-meds know they need the courses, the grades, and the MCATs. Rote over reason is a well-known path to those ends. Universities treat their pre-meds (and other pre-health science students) like soldiers. Standardized interviews with faculty are done, so only one standard evaluation form need be sent out to all the schools the student applies to. To do well in this interview, the student has to have a record of 'service' activities--clearly padded for that purpose in many cases--and talk a good game about why they want to be doctors.

They know the game, and they game it! Of course, there are always the fraction of truly dedicated, devoted, honorable, broadly trained people who you want to help into the best med schools. You hope one of them will be carving on you when you undergo your next surgery.

Can the fraction of those kinds of people be increased? The idea of breaking down the gamed, cookie-cutter system seems like a good one. If students knew that thinking, not just knowing 'the answer', would be rewarded, they might be better students, more worthy of faculty time and effort. And they might be better judges of complex phenomena like health--better able to evaluate complex data and literature, and more likely to understand patients as people.

Of course, medicine is an advanced art, properly technical in many ways. But if the hyper-competitive, hyper-technology drive undergraduate student can be rewarded for thinking more synthetically, we might get better medical care, and they might have more broadly rewarding lives, too.

9 comments:

Henry Harpending
said...

Ken, what is the evidence about this? Academics have been bad-mouthing things like GREs for the last few decades directly in the face of all the evidence.

Personally I want my physician to know Bayes theorem but I don't care very much whether or not he is sensitive. I don't enjoy teaching the pre-med grinds any more than you do. On the other hand I really don't want an intellectually lively and curious physician working on my gall bladder, I want a good tech.

Yes, Henry, when the scalpel comes out I want someone who knows which end is up. One could argue whether 'artist' or 'tech' is the right word, if it makes a difference. But in any case someone who has a good control and intuitive understanding.

I'd quibble about GREs, but there are a lot of ways to argue that.

In any case, if it makes any difference, and maybe it doesn't (whether the med student majored in chemistry or French history), or if it just goes in cycles, my preference based on my thousands of pre-med-training experiences is for the more thoughtful and less pure GPA-driven ones.

Anyway, one can argue the point, and when it comes time (and our time is coming!) we would certainly agree we want treatment, not philosophy (unless the philosophy has to do with quality of the end of life vs what kinds of gruesome not-very-effective therapies to offer)

Henry, med schools probably rediscover once a generation or so the fact that humanities undergrads can learn anatomy -- and probably even Bayes theorem. I'd bet it makes a lot less difference what a med student learned as an undergrad than we usually think.

Yes, I agree with Anne but would put it another way. A more intellectually curious -- and good!-- undergrad may be more desirable as a med student than a GPA-driven tekky.

But the point as you put it is rather moot. That's because the point is who gets into med school, not who is handed a scalpel. If the French major can't cut straight, s/he will flunk out of med school and end up teaching French.

So, I don't think we disagree about that, but perhaps about how to identify the smart, intellectually capable people. We might disagree about how synthetic and so on we'd like our docs to be. But no matter, they certainly have to know how to read an x-ray or write the proper prescription.

But Ken and Anne, you have offered not a single fact that recruiting more of these "humanities" types to med school makes any difference in the end product. Indeed, your argument seemed to rest on a claim that it didn't (and, hence, we should recruit more of them). Why? If it ultimately makes no difference (something I am not the least surprised about), then who cares the what the source of recruitment is? What you need is evidence that recruiting English, Philosophy, History and Music majors makes a positive difference in medical practise.

McMaster University in Hamilton, Ontario, Canada has claimed such evidence for years. They were among the first to eschew the traditional med school wannabes in favour of the others you describe. I have no idea how good the evidence for their claim is. But some such evidence would seem to be relevant.

John, this seems like yet another outcome that's difficult to measure. It wouldn't seem fair to ask that the humanities types be at the top of their class; maybe it's a bad sign if they all cluster at the bottom, but then, medical students who came from science and graduate in the bottom of their classes are licensed too. So it's hard to know what to measure.

Though, all else being equal, I assume the 'positive difference' we're looking for is bedside manner -- humanities types have better bedside manner than strictly science types. But how do you measure that? And Henry doesn't care if his doctor has compassion, but Ken thinks it matters at the end of life.

Given that we're about to give maybe 30 million more people easier access to medical care in the US, probably it's all about how to make more doctors quickly. Admitting anyone who's reasonably smart no matter their background into medical school is one way.

I guess my main take on this is the result of teaching genetics to so many pre-meds over the years. I think that overall, broader training is better. The study did show, as I recall, that the humanities-trained pre-meds ended up in the less purely technical areas of medicine, which is appropriate.

I think that it also depends on the type of medicine the students are training for. I really want a great technician when they eventually have to take out my appendix or gall bladder or tumor. On the other hand, I'd much rather have an anthropologically trained general physician, who can synthesize culture, biology, genetics, and Bayes theorum when making decisions about how to treat many of the conditions that require long-term management with variable guidelines.

Hi Ken and Anne! Enjoying the blog - and finally given over to writing in.

Bethany, It's great to hear from you!I don't think there is any reason to think that more broadly thinking physicians would not be good surgeons, or perhaps that narrowly trained undergraduates would be as trainable at high levels to be surgeons.

Otherwise, of course I agree that synthetic approaches can treat whole patients, not just their organs. If we're learning anything, it is that our systems are far more connected than had been thought.

The system we have for pre-med training is good for recruiting those who can grind away and get grades, but I'm not convinced that by and large they are going to be even the best technical docs.

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